Have you ever had bald spots, thinning edges, or a red and irritated scalp? Well read on, Sis, because Dr. Adeline N. of @brownskinderm is here with all of the information you need to know about Traction Alopecia, which is a form of hair loss caused by repetitive and prolonged tension on hair roots. TA is more prevalent than you might think, so it’s important to know how to prevent it, as it could result in irreversible hair loss in its worst case scenario.

What is traction alopecia?
Dr. Adeline: Traction alopecia unfortunately often results in scarring and/or permanent loss of hair, depending on the extent of the pulling and duration of traction. Due to certain styling choices that are harmful to the hair and an even more tender hairline, many women have fallen prey to the negative effects of traction alopecia.

Traction alopecia can be divided into two types: marginal and non-marginal. Marginal is more common, as it occurs along the hairline or “edges,” resulting from traumatic hairstyling. Non-marginal TA is hair loss caused by styling tools such as hairpins or buns, not necessarily around the hairline.

What exactly causes traction alopecia?
Dr. Adeline: The development of TA falls into two major categories—traumatic hairstyling practices and application of chemicals and/or heat to the hair. While the convenience of extensions, wigs and other protective hairstyles can seem appealing, overuse can cause reoccurring stress on the scalp, resulting in TA. Frequent use of tight and/or heavy buns, ponytails, braids, weaves or hair extensions, as well as cornrows and dreadlocks are believed to be the highest risk hairstyles, especially when associated with chemically relaxed hair (which is already more prone to breakage). Additionally, one can experience traction alopecia with other practices that cause constant friction and pressure on the scalp. I have diagnosed several nurses who have had hair loss from wearing nursing hair bonnets and construction workers wearing heavy helmets.

How does a person know if they might have traction alopecia?
Dr. Adeline: Patients experiencing TA may complain of symptoms such as redness in the areas of the scalp exposed to maximum tension which may progress to bumps referred to as tension folliculitis and even blisters. Stinging or scalp tenderness during hairdressing may also be present, which may be associated with headaches. These signs may appear early or later, making it difficult to know if they are associated with TA.

It is worth noting that these symptoms may also overlap with other types of hair loss and as such are not unique only to TA. Also, not every hair loss around the hairline is necessarily traction alopecia. There are several other types of hair loss and/or disorders that could be the culprit.

For example, I had a patient who for years had been using over-the-counter medications to treat hair loss on her edges with the belief that she had traction alopecia, but an evaluation of her scalp with dermoscopy (a magnifying tool with special lighting) and a scalp biopsy showed her hair loss was actually due to an auto-immune disorder.

My advice to someone who truly feels they might have TA is to first stop all practices that may be contributing to the hair loss and to seek medical intervention by a dermatologist who is trained to identify the unique clinical features. This dermatologist should perform appropriate examinations such as scalp biopsies where the hair root can be analyzed microscopically to yield the most appropriate diagnoses in order to administer the right intervention. Not doing so could exacerbate the situation and possibly cause irreversible hair loss.

How do I prevent traction alopecia in the first place?
Dr. Adeline:

1. Wear loose hairstyles as much as possible.

2. Avoid the overuse of heat and chemical exposure to hair.

3. Don’t tolerate pain during hairstyling! This is a sign of excessive use of tension on the scalp and should be avoided at all costs. If you have “tenting” of the hair follicle, which is elevation of the scalp skin due to tight pulling, the style is too tight and could cause damage.

4. Don’t hesitate to give specific instructions to hairdressers, especially when styling kids’ hair in order to avoid high tension styles, as TA is also common in kids.

Is there anything I can do to reverse the effects of traction alopecia?
Dr. Adeline: Yes, TA can be treated and reversed if it has not reached the level of permanence but you must first start by eliminating ALL traumatic styling habits. Switch from high risk hairstyles to low risk ones now because in its later stages, TA may progress into an irreversible scarring alopecia.

Your dermatologist may prescribe a steroid to apply on the scalp or inject it among other oral therapies aimed at reducing the inflammation of the scalp. For severe cases, a hair transplant can be considered as a surgical intervention.

But the take home message is: late stage TA can be very difficult to treat if not futile—so early prevention and intervention is a must.

Dr. Adeline N.

Finally, it’s important to note that any racial and ethnic group can be affected by TA because any behavior that causes increased tension to the scalp can result in TA. However, in the US, the group most affected are women of African descent with one third of them believed to have TA.

In conclusion, ladies please always remember to be gentle with your hair and scalp! We all love looking our best but no style is worth the pain, let alone the ultimate possibility of losing your hair in that area for good.

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